HomeMy WebLinkAboutXC2022-1974 - Permit ApplicationPrint Form Worksheet for Combo Building &Solar Permit Application ?E °a>
F- Comm'I F- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SIIRMITrAI
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Address (Not mailing address) [ Flood F- Fire [ Liq f- Landslide C-N/A Floor Suite No
Description of Work Use F7Const Type
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Valuation S
New/Add SF Remodel SF� Garage/New/Add CV Mate al/Labor `_
OWNER'S NAME Last
Owner's Address Owner's E-mail Address
City State Zip �— Telephone !f (p - 575-5
APPLICANT'S NAME Last First
Applicant's Address A licanfs E-mail Address
City State — Zip F ---- _..--
Telephone
ARCHITECT/DESIGNER'S NAME Last First Lic. No. _ 4
Architect/Designer's Address Architect/Designees E-mail Address
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CityyL� State Zip �— Telephone
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ENGINEER'S NAME Last First Lic. No
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Engineer's Address e)6; 61YE `YN& Engineer's E-mail Address
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City aJV� .. - �/c j State Zip ..._Cj'Lj Telephone W % / / - Kr� r
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CONTRACTOR'S NAME/COMPANY CZ''�'"`--her lc'IYIl11l
Lic. No. Class115110 J
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Contractors Address Contractor's E-mail Address
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City � � / � State �A Zip 7 Telephone �L&-C?g7 ?
SETBACKS REAR SETBACKS FRONT PERMIT NO. X
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK O.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $